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I was greatly moved by the
information shared by members of ASCR throughout
the conference last September. In the wake of
Katrina, Rita and Wilma, stress management has
become vital to the functioning of employees
doing cleanup and restoration after these hurricanes.
Disaster, death and violence are incidents that
are directly linked to Posttraumatic Stress
Disorder. The reduction of long-term effects
and hidden emotional damage caused by such incidents
should be an issue addressed by all companies
involved in trauma response. It is easy to say
that our employees will "get over it"
in time, but all of us are prone to Posttraumatic
Stress Disorder if the circumstances are right.
Psychological distress can be hidden, leaving
us exposed to cumulative stress reactions. If
the stress continues to build up, our bodies
develop stress-related symptoms and physical
illness results.
We normally deny, ignore or minimize all kinds
of stress: however, disasters, acts of terrorism,
death of colleagues and death of children all
disrupt our basic belief that we are safe and
secure. We want to believe that we can face
any situation and that we have all the tools
we need for coping. Therefore, it is easier
to deny stress than to admit that our tools
do not fit the situation or our needs. When
we are suddenly confronted by a traumatic and
shattering experience, our safe and secure world
can collapse, resulting
in: fear and confusion, the loss of our belief
systems, self-worth and value as human beings.
If our equilibrium is not restored, depression,
a sense of pointlessness and even suicide can
result. If our response to stress continues
to build up over time, we develop cumulative
stress reactions, resulting in stress-related
symptoms and illnesses. Untreated stress can
cause a slowing of the immune system. Organs
give way to progressive destruction. The results
are manifested in a range of disorders and diseases
ranging from heart attacks to cancer.
We live with general stressors and stress symptoms
from the moment we wake until we go to bed.
Stress is brought on by the events and demands
in our lives and our actions and reactions to
these events. Stress has its inception both
outside of us -in the work we do- and
within us-our response to work. The
management of stress involves working with our
selves and these events and demands. The focus
of incident stress management is to change our
thinking and reactions to stressful events so
that stress can work for us in a positive way.
Understanding the stress response can help
employers recognize when an employee is in trouble.
I have encountered four stages to incident stress.
Stage of Anticipation comes
right after we are notified of the incident.
Anticipatory stress deals with the unknown.
We have no idea of what we are facing and no
idea of what to expect. In this stage, we doubt
ourselves and our ability to be able to do the
job.
The media plays an important part in this stage
and can often terrify our psyche into believing
we are incompetent because the incident is "too
overwhelming". We forget that the media
plays up the worst events, leaving us to believe
that the critical incident is earth shattering.
Stage of Reality Shock develops
when we arrive at the site. Often we are overwhelmed
by the task at hand. This stage brings anxiety,
a sense of shock, a feeling that we cannot do
enough to help. Also, this stage can lead to
the need to work feverishly. A fireman who worked
after 9/11 told me he was driven to dig with
his hands, since he did not have a shovel. It
was only after he saw that his hands were bleeding
that he realized what he was doing. This stage
defines the abnormal event in terms of mental
traumatization.
Stage of Desperation/Stage of Acute
Reactions develops after the job is
completed. It is normal to push physical and
psychological stress out of the way until the
job is done. After we complete a difficult task,
withdrawing, feeling abandoned or "different",
and having thoughts that no one understands
are all normal perceptions of an abnormal situation.
Feelings of depression, anguish, remorse and
sadness can result. Talking about the incident
becomes difficult, and we become introspective.
We start questioning our belief systems, our
lives, our faith and who we are. We feel guilty
because we did not do enough. We become vulnerable,
and our world as we knew it has collapsed. These
post-traumatic stress reactions are normal responses
to abnormal events.
However, in this stage we can lose a purpose
for living, and this sense of pointlessness
can lead to suicide. It is also this stage that
can lead to affect disintegration: chronic illness
emerges, psychotic episodes develop, loss of
trust shatters meaningful attachments, chronic
guilt and self-blame becomes intrusive. Relative,
friends and colleagues do not want to hear about
the incident and we feel that they no longer
are giving support. As a result, loneliness
and isolation can develop. What can emerge is
Posttraumatic Stress Disorder (PTSD). The degree
of stress experienced is proportional to these
five factors:
1. The amount of empathy one possesses
2. Past traumatic events one has experienced
3. Unresolved traumatic conflicts one may
harbor
4. The amount of exposure to family, children's
or friends' trauma
5. The degree of maladaptive responses one
uses as a survival strategy
Number two addresses cumulative stress. Cumulative
stress compounded by a catastrophe can cause
emotional and physical breakdown. Cumulative
stress is subtle and often ignored, denied and
minimized because the stress starts to feel
normal. Unfortunately, major life changes develop.
Marital problems rank first as the inducing
factor to a cumulative stress response. It is
often easier to blame an event than to make
life changes. If our response to stress continues
to build up, our bodies develop stress-related
symptoms and illness results.
Stage of Reconciliation/Stage of Acute
Posttraumatic Stress is when we live
through and learn from our stress. The underlying
attitude an individual brings to a stressful
situation largely determines whether the stress
will be used for growth or be debilitating.
In this stage we can grow from the traumatic
event and incorporate it into our psyche, or
we can develop acute Posttraumatic Stress Symptoms.
Distress during the days that follow the incident
resemble those of PTSD; however, it is difficult
to differentiate between normal responses to
an abnormal incident and responses that develop
into PTSD.
Terrorism is a new form of incident stress
that demands more than adaptation and coping.
The stress of terrorism necessitates a confrontation
with the threat of helplessness, death and mutilation.
Another element to the entity of trauma is the
way the incident and past incidents become a
way to haunt the individual's functioning in
the present. The results are fear and uncertainty
because the sequential stressors have a cumulative
effect. Oklahoma City, Columbine and September
11 represent an assault on our sense of personal
safety and belief in humanity. This shattering
of beliefs can traumatize the individuals in
the restoration field to a greater degree than
what is experienced by a primary victim because
it is cumulative, group related, ongoing, affects
the functioning of a group, and is often viewed
as individual pathology and not as an "event
that happened to the United States of America".
There is a cost to caring and the price can
be individual, as well as large group disintegration.
In short, it is easy for every one of us to
set ourselves up for stress reactions. Without
normalizing the situation, we have no idea that
the symptoms we exhibit are symptoms the normal
population would express. We cannot always change
the events and demands in our daily lives, but
we can change our way of looking at those events
and our reaction to stressful demands.
In my book, Cumulative Stress Management
for Search and Rescue: A Workbook for all Emergency
Personnel, the premise is simple: We
all need to practice ways in which we can define
ourselves by our typical moments and not our
worst moments. This key to surviving incident
stress is paramount to our functioning because
it puts us in control. The acceptance and insight
into who we are and how we respond to stress
are keys to our mental health. In other words,
learning to grow from stress reactions, finding
ways to deal with uncertainty, meditation and
relaxation, coming to terms with death, taking
care of our bodies physically, and helping our
loved ones cope with the stress are all critical
"defusers" to stress management for
emergency workers. Since I believe that every
one of us needs to take responsibility for our
ongoing health, having tools to reduce our stress
is the key to prevention.
So, what is the answer? Studies have shown
that training for stressful events protects
individuals from the effects of stress. Ongoing
training can reduce uncertainty, increase one's
sense of control, and teach automatic responses.
Training is effective in generating positive
response outcome. * Reading positive affirmations
concerning one's abilities enroute to the incident
can also have the same effect in reducing uncertainty.
**
The urgency to prepare our personnel for future
man-made disasters and acts of terrorism so
that psychological effects will be minimal is
paramount. We need to reexamine our procedures
so that our employees are protected from environmental
harm during and after their work. Since interventions
concerning man-made disasters are different
from natural disasters, we need to focus on
this new frontier: terrorism and human-constructed
disasters. Oklahoma City and September 11 were
America's largest man-made horror shows. The
very thought that we could become a battleground
to terrorism devastates the normal American
concept of good will. Let us use what we have
learned from these events and develop positive
scenarios for the future. Hopefully time and
and preparation will increase our knowledge
and lessen the impacts of future disasters.
Marilyn Neudeck-Dicken, Ph.D. is a pioneer
in the area of traumatic stress and has decades
of experience based on extensive research and
firsthand knowledge. She has been involved in
incidents such as the Oklahoma City bombing,
four Mobil explosions, the Columbine shootings,
and the Cerritos and San Diego plane crashes.
She can be reached at drmend2@yahoo.com.
References:
*Chemtob et al.1990; Hytten 1989'
**Neudeck-Dicken, 1997
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